Covered Entity Details

CH06476B St Gabriel Health Clinic Inc (Active) - information as of 4/25/2025 7:28:02 PM

Main Details

Name

St Gabriel Health Clinic Inc

Subdivision Name

The Gardere Center for Primary Care Services operated by sghc, Inc.

Type

HRSA-Funded Health Center

Site ID

BPS-H80-013551

340B ID

CH06476B

Grant Number

H80CS00551

Additional Details

Current Program Status

Active

Registration Date

1/4/2021

Participating Start Date

4/1/2021

Participating Approval Date

1/5/2021

Last Recertification Date

3/10/2025

Contacts

Authorizing Official

St. Gabriel Health Clinic, Inc.
Ashley T Levy, CEO
(225) 642-9676 Ext: 119

Primary Contact

St. Gabriel Health Clinic, Inc.
Lyssa Morris, Administrative Liason
(225) 642-9676

Addresses

Street Address

1707 Gardere Ln
Baton Rouge, LA 70820-8144

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH064760	Active	BPS-H80-002394	ST GABRIEL HEALTH CLINIC INC	ST. GABRIEL HEALTH CLINIC, INC.	5760 Monticello Dr	Saint Gabriel	LA
CH06476B	Active	BPS-H80-013551	St Gabriel Health Clinic Inc	The Gardere Center for Primary Care Services operated by sghc, Inc.	1707 Gardere Ln	Baton Rouge	LA
CH06476C	Active	BPS-H80-010654	St Gabriel Health Clinic Inc	East Iberville Math, Science and Arts Academy	1825 Highway 30	Saint Gabriel	LA
CH06476D	Active	BPS-H80-002893	St Gabriel Health Clinic Inc	EAST IBERVILLE ELEM/HIGH SCHOOL	3285 HIGHWAY 75	SAINT GABRIEL	LA
CH06476E	Active	BPS-H80-027719	St Gabriel Health Clinic Inc	St. Gabriel - Celerity-Dalton	3605 Ontario St	Baton Rouge	LA
CH06476F	Active	BPS-H80-027718	St Gabriel Health Clinic Inc	St. Gabriel - Celerity-Lanier	4705 Lanier Dr	Baton Rouge	LA
CH06476G	Terminated	BPS-H80-018027	St Gabriel Health Clinic Inc	Glen Oaks Middle School Primary Care Center operated by SGHC,Inc.	5300 Monarch Ave	Baton Rouge	LA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Carve-In Effective Date	Termination Date
CH064760	LOUISIANA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 10318	9326 BURBANK DRIVE	BATON ROUGE	LA	70820	01/01/2021

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/5/2024 2:30:49 PM	3/10/2025 6:56:22 PM	3/10/2025 6:56 PM
Contacts	Authorizing Official	Update	AO Change Request	Wade, Shirley F NP, Admin Liaison St. Gabriel Health Clinic Inc. 2256429676-119	Levy, Ashley T CEO St. Gabriel Health Clinic, Inc. 2256429676-119	3/10/2025 6:18 PM
Contacts	Primary Contact	Update	AO Change Request	Pullen, Estelle A Interim CEO St Gabriel Health Clinic Inc 2256429676-104	Morris, Lyssa Administrative Liason St. Gabriel Health Clinic, Inc. 2256429676	3/10/2025 6:18 PM
Contacts	Authorizing Official	Update	Profile Change Request	Wade, Shirley F CEO St. Gabriel Health Clinic Inc. 2256429676-119	Wade, Shirley F NP, Admin Liaison St. Gabriel Health Clinic Inc. 2256429676-119	2/6/2024 7:39 AM
Contacts	Signed By	Update	Profile Change Request	Wade, Shirley F CEO St. Gabriel Health Clinic Inc. 2256429676-119	Wade, Shirley F NP, Admin Liaison St. Gabriel Health Clinic Inc. 2256429676-119	2/6/2024 7:39 AM
Contacts	Primary Contact	Update	Profile Change Request	Pullen, Estelle A COO St Gabriel Health Clinic Inc 2256429676-104	Pullen, Estelle A Interim CEO St Gabriel Health Clinic Inc 2256429676-104	2/6/2024 7:29 AM
Details	Last Recertification Date	Update	Recertification	2/8/2023 10:21:55 AM	2/5/2024 2:30:49 PM	2/5/2024 2:30 PM
Contacts	Primary Contact	Update	Recertification	Pullen, Estelle A Interim CEO St Gabriel Health Clinic Inc 2256429676-104	Pullen, Estelle A COO St Gabriel Health Clinic Inc 2256429676-104	2/5/2024 2:30 PM
Contacts	Primary Contact	Update	Profile Change Request	Pullen, Estelle A COO St Gabriel Health Clinic Inc 2256429676-104	Pullen, Estelle A Interim CEO St Gabriel Health Clinic Inc 2256429676-104	2/5/2024 2:30 PM
Details	Last Recertification Date	Update	Recertification	2/21/2022 12:00:07 PM	2/8/2023 10:21:55 AM	2/8/2023 10:21 AM
Details	Last Recertification Date	Update	Recertification		2/21/2022 12:00:07 PM	2/21/2022 12:00 PM
Details	State	Update		Approved	Active	4/1/2021 12:01 AM
Contacts	Signed By	Insert	New Registration		Wade, Shirley F CEO St. Gabriel Health Clinic Inc. 2256429676-119	1/5/2021 11:20 AM
Details	340B ID	Update	New Registration		CH06476B	1/5/2021 11:20 AM
Dates	Participating Approval Date	Update	New Registration		1/5/2021 11:20:10 AM	1/5/2021 11:20 AM
Details	State	Update	New Registration	Pending	Approved	1/5/2021 11:20 AM
Dates	Signed By Date	Update	New Registration		1/5/2021 10:45:36 AM	1/5/2021 11:20 AM
Dates	Start Date	Update	New Registration		4/1/2021 12:00:00 AM	1/5/2021 11:20 AM
Addresses	Main Address	Insert	New Registration		1707 Gardere Ln Baton Rouge, LA 70820-8144	1/4/2021 1:59 PM
Contacts	Authorizing Official	Insert	New Registration		Wade, Shirley F CEO St. Gabriel Health Clinic Inc. 2256429676-119	1/4/2021 1:59 PM
Contacts	Primary Contact	Insert	New Registration		Pullen, Estelle A COO St Gabriel Health Clinic Inc 2256429676-104	1/4/2021 1:59 PM
Details	Assistance Received From Date	Insert	New Registration			1/4/2021 1:59 PM
Details	Assistance Received To Date	Insert	New Registration			1/4/2021 1:59 PM
Details	Last Recertification Date	Insert	New Registration			1/4/2021 1:59 PM
Details	Grant Number	Insert	New Registration		H80CS00551	1/4/2021 1:59 PM
Details	340B ID	Insert	New Registration			1/4/2021 1:59 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/4/2021 1:59 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/4/2021 1:59 PM
Details	Medicare Provider Number	Insert	New Registration			1/4/2021 1:59 PM
Details	Entity Name	Insert	New Registration		St Gabriel Health Clinic Inc	1/4/2021 1:59 PM
Details	NOFO Number	Insert	New Registration			1/4/2021 1:59 PM
Details	Program Code	Insert	New Registration		CH	1/4/2021 1:59 PM
Details	Entity Subname	Insert	New Registration		The Gardere Center for Primary Care Services operated by sghc, Inc.	1/4/2021 1:59 PM
Dates	Participating Approval Date	Insert	New Registration			1/4/2021 1:59 PM
Details	State	Insert	New Registration		Pending	1/4/2021 1:59 PM
Dates	Registration Date	Insert	New Registration		1/4/2021 1:59:44 PM	1/4/2021 1:59 PM
Dates	Signed By Date	Insert	New Registration			1/4/2021 1:59 PM
Dates	Start Date	Insert	New Registration			1/4/2021 1:59 PM
Terminations	Termination Comments	Insert	New Registration			1/4/2021 1:59 PM
Terminations	Termination Date	Insert	New Registration			1/4/2021 1:59 PM
Terminations	Termination Effective Date	Insert	New Registration			1/4/2021 1:59 PM
Terminations	Termination Reason	Insert	New Registration			1/4/2021 1:59 PM

340B Drug Pricing Program Database